Transfusion Medicine Case 159 October 2, 2025 rmalaca1 Please wait... 1. Presented by Ahmad Kohsar, DO, MS and reviewed by Lorraine Blagg, MA, MLS(ASCP)CMSBB, AHI(AMT) A patient with an unknown medical history was found obtunded and unresponsive and was admitted to the ICU. They were found to be anemic with a hemoglobin of 6.5 g/dL. They were transfused a unit of RBCs. During the transfusion of the red cells, they spiked to a temperature up to 38.9°C from a baseline of 37.5°C. Additionally, they had persistent hypoxia with O2 saturation in the high 80s, requiring supplemental oxygen. Recent imaging just before transfusion shows a unilateral consolidation possibly from aspiration, and they appeared euvolemic with normal pressures and normal BNP. The results of the transfusion reaction workup are as follows: Blood Bank HistoryPatient ABO/Rh: A POS Antibody Detection: Negative Requirements: Leukoreduced RBCs Transfused RBCs: A POS Blood Product RequisitionDemographic information matched Special Requirements: Leukoreduced Patient Location: ICU Patient’s ABO/Rh: A POS Blood Component Type: RBCs Blood Component ABO/Rh: A POS The blood component is crossmatch-compatible Patient Plasma Hemolysis Check: Negative Observation of Transfusion Line for Hemolysis: Negative Blood Component ABO/Rh:Anti -AAnti-BAnti-D4+04+Pre-Sample DAT:Polyspecific IAT (Anti-IgG and Anti-C3)Check Cells02+Pre-Sample ABO/Rh:Front Type:Anti -AAnti-BAnti-DMonoclonal Control4+04+0Reverse Type:A1 cellsB cells04+Pre-Sample Antibody Detection: LISS37 CIATCCScreening Cell I002+Screening Cell II002+37: Incubation at 37C IAT: Indirect Globulin Test (Anti-IgG) CC: Check Cells Pre-Sample Crossmatch: LISSRBCs37CIATCCTransfused Unit002+Post-Sample DAT:Polyspecific IAT (Anti-IgG and Anti-C3)Check Cells02+Post-Sample ABO/Rh:Front Type:Anti -AAnti-BAnti-DMonoclonal Control4+04+0Reverse Type:A1 cellsB cells04+Post-Sample Antibody Detection: LISS 37 CIATCCScreening Cell I002+Screening Cell II002+Post-Sample Crossmatch: LISSRBCs37CIATCCTransfused Unit002+Preliminary gram stain and cultures have been negative to date. Question: What is the most likely cause of these findings?A. Hemolytic transfusion reactionB. Transfusion Associated Circulatory OverloadC. Transfusion-Related Acute Lung InjuryD. Transfusion-associated sepsisE. Febrile nonhemolytic transfusion reaction, but possible underlying disease Loading...